Membership Application
1
Create Profile
2
Member Agreement
3
Personal Info
4
Additional Member
5
Program Selections
6
Health History
7
Review
8
Activation
1 of 7
Create Profile
Next: Member Agreement
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Let’s get started by identifying the type of membership that you need. Select from one of the following:
General Membership:
You are the individual that will be responsible for your membership.
Member Only
Member + One
Member + Family
Guardian Membership:
I'm applying as the Guardian of someone else's Membership.
Group Membership:
My Membership is being sponsored by my Group and I have been given a Payment Token.
Please enter last 4 digits of your Social Security Number so we can match you to your Group.
I certify that I am completing this application on behalf of myself, as the Applicant, and NOT on behalf of another (Unless it is a Guardian application. Guardian applications may be submitted by the guardian). I understand that I am NOT AUTHORIZED to complete this application on behalf of another, and that Impact Health Sharing may cancel or deny membership, and/or the payment of any otherwise eligible medical bill associated with this application, if this application has been completed on behalf of someone other than myself.
User Registration:
Now let's setup a password for your membership. Your email address will be your username. Please, follow the instructions to complete your application and then activate your account. You can save your application and return back to
mysharable.com
at anytime.
First Name
*
Middle Name
Last Name
*
Email
*
Phone
*
Date Of Birth
*
Password
*
Confirm Password
*
Referral Code/IBO Number
include at least one number and symbol
include both lower and upper case characters
be at least 8 characters with no spaces
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